Factors associated with the intent of firearm-related injuries in pediatric trauma patients
G. Li, S. P. Baker, C. DiScala, C. Fowler, J. Ling and G. D. Kelen
Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Md, USA.
OBJECTIVE: To examine the characteristics of unintentional and assaultive
firearm-related pediatric injuries treated in trauma centers. DESIGN:
Comparative analysis of patients 14 years or younger who were admitted to
the trauma centers because of unintentional firearm-related injuries (n =
292) vs assaultive firearm-related injuries (n = 457). SETTING: Sixty-eight
trauma centers or children's hospitals in the continental United States and
Canada that reported data to the National Pediatric Trauma Registry from
January 1, 1990, through December 31, 1994. MAIN OUTCOME MEASURES:
Frequency distributions of firearm-related injuries in relation to intent
and injury circumstances, odds ratios (ORs) on the intent of injury being
assaultive, injury severity scales, and in-hospital fatality rates.
RESULTS: The frequency of unintentional firearm-related injuries rose in
the afternoons peaking between 4 and 5 PM; they predominantly occurred at
home (89%). Assaultive firearm-related injuries peaked sharply between 8
and 9 PM and usually occurred on roads or in other public places (63%).
About 3 times as many boys as girls were harmed in firearm-related
injuries. Given a firearm-related injury resulting in admission to a trauma
center, the adjusted OR of it being assaultive was 2.8 (95% confidence
interval [CI], 1.6-4.6) if the victim was a girl, 4.9 (95% CI, 3.1-7.8) if
the shooting occurred at night, 2.6 (95% CI, 1.6-4.2) if the shooting
occurred on a weekday, and 21.1 (95% CI, 9.1-49.4) if the shooting occurred
on a road. Injury patterns and severity were similar between patients with
unintentional and assaultive injuries. Overall, 19% of the patients
sustained head injuries, which contributed to 90% of the in-hospital
deaths. CONCLUSIONS: Marked differences in injury circumstances exist
between unintentional and assaultive firearm-related injuries among
children. The late afternoon hours when many children have come home from
school but their parents may still be working have the highest frequency of
unintentional firearm-related injuries. The evening peak of assaultive
injuries may be related to drug-related and gang-related violence. While it
is important to reduce the access of firearms to children, school-based
extracurricular and community-based social services should be considered in
developing intervention programs.
